Purpose-fit technical infrastructure

SmartCare’s main aim is to implement and validate ICT based support for integrated healthcare, social care and self-care (informal care), for different health / living conditions, along integrated care pathways for improved health and wellness. This integrated care is to occur mainly outside the hospital, in the home or community of the care recipient (CR). Many stakeholders are to be served by the integrated service model: healthcare providers, social care providers, informal care providers, third sector care providers, and the care recipients / patients. Each of the stakeholders has a different perspective, and needs access to services and information at different levels of detail and points on the pathways. It is hoped that an integrated platform and service model will allow for appropriate access by each stakeholder, as well as provide an integrated view of the CR's needs in the clinical and social realms.

The care pathways developed in the first work packages provide the starting point for the development of the technical specification, as ICT components support the care pathway workflows and use cases.

Technical specifications were produced as an overlay to the original pathway, listing IT infrastructure components (such as LAN, wireless networks, databases), IT systems (such as electronic health records, telehealth devices), and functionalities needed for each step.

Defining the SmartCare System

The SmartCare project developed two care pathways that used similar functional blocks:

  • enrolment and consent
  • integrated care plan
  • on-site provision of care
  • remote provision of care through telemonitoring or telecare
  • documentation of care
  • assessment and re-assessment of care needs
  • exit from the service. 

Each of the deployment sites used different IT to support the functional blocks for the care pathways.

Simplified Functional Diagram for SmartCare

 These functional descriptions are shown in the table below along with input, output, users, system interfaces, possible communication methods and standards, and possible messaging methods and standards.

 

Functional

blocks

Inputs Outputs Users Sytem Interfaces

Possible Communication

Methods/Standards

Possible Messaging

Standards

Enrolment and
Consent
CR Demo-graphics,
Discharge plan,
Request / Referral by
community resources
Discharge summary and
recommendation for
care
HCP,
SCP, CR,
I/FC
Healthcare Record
System; GP Record
System
Database based, electronic
message based (e-mail, text
message, phone call, fax)
IHE ITI BPCC, PDQ;
national standards as
promulgated by
deployment sites;
epSOS recommended
standards
Care Plan CR Information,
Discharge summary,
possible care
protocols
Integrated protocol /
plan for CR
HCP,
SCP,
TCP,
I/FC, CR
Healthcare Record, GP
Record System;
Community health and
social care record
Database based; electronic
message based (e-mail, text
message, phone call, fax);
wireless or wired, a
configured device, PC based
or mobile handset; interface
to hub could be a specific
application or web-based;
TCP/IP; web-based protocols
HL7 CDA R2; IHE ITI
XCA, XDM, XDE, XDS,
XDS-SD, PDQ, PDQv3,
PIX, PIXv3; IHE PCC
MS, XPHR, CM
 On site
provision of
care
 CR information, care
requested / needed,
scheduling of care
 Care provided,
modification to care
plan
 HCP,
SCP,
TCP,
I/FC, CR
 Caseload Management
and Appointment
scheduling; Community
health and social care
record 
 Electronic message based (email,
text message, phone
call, fax); wireless or wired, a
configured device, PC based
or mobile handset; interface
to hub could be a specific
application or web-based;
TCP/IP; web-based protocols
 HL7 CDA R2; IHE ITI
XCA, XDM, XDE, XDS,
XDS-SD, PDQ, PDQv3,
PIX, PIXv3; IHE PCC
MS, XPHR, CM
 Remote
provision of
care and
support
 Vital parameter
monitoring, telecare
/ smart home
monitoring,
educational material
/ content, scheduling
of care, directory of
services
 Vital parameter
measurement, telecare
/ smart home
measurements and
alarms, educational /
training information /
content, alerting of out
of range parameters,
virtual coaching (audio
/ video
teleconferencing),
service information
 HCP,
SCP,
TCP,
I/FC, CR
 Telehealth / telecare
system sensors,
aggregator (hub – which
could be paper record;
wireless or wired, a
configured device, PC
based or mobile handset;
interface to hub could be
a specific application or
web-based), call centre,
service directory
database
 Electronic message based (email,
text message, phone
call, fax); wireless (Bluetooth,
ZigBee, WiFi, GSM
(2G/3G/4G)), wired (PSTN,
ISDN); TCP/IP; web-based
protocols
 IEEE 11073 PHD data
standards, HL7 CDA
R2; Continua
certification; IHE PCD
DEC, RTM, ACM;
IEEE802.15.4 (ZigBee)
 Documentation
of care
 Care provided,
modification to care
plan, vital parameter
measurement, smart
home measurements,
educational /
training information
/ content, alerting of
out of range
parameters, virtual
coaching (audio /
video
teleconferencing)
 Document / message /
proof of care provided,
modification to care
plan, vital parameter
measurement, smart
home measurements
educational / training
information / content,
alerting of out of range
parameters, virtual
coaching (audio / video
teleconferencing)
HCP,
SCP,
TCP,
I/FC, CR
 
 Telehealth / telecare
system, call centre,
community health and
social care record;
paper based; wireless or
wired, a configured
device, PC based or
mobile handset; interface
to hub could be a specific
application or web-based
 Database based; electronic
message based (e-mail, text
message, phone call, fax);
wireless or wired, a
configured device, PC based
or mobile handset; interface
to hub could be a specific
application or web-based;
TCP/IP; web-based protocols
 HL7 CDA R2; IHE ITI
XCA, XDM, XDE, XDS,
XDS-SD, PDQ, PDQv3,
PIX, PIXv3; IHE PCC
MS, XPHR, CM
 Assessment
and
reassessment
of care
 Care plan, care
provided by all
means (on-site and
remotely), CR
progression through
plan
 Modification to care
plan, emergent care
escalation request,
recommendation for
SmartCare service exit
 HCP, SCP   Community health and
social care record;
health record; GP record
system
 Database based; electronic
message based (e-mail, text
message, phone call, fax);
wireless or wired, a
configured device, PC based
or mobile handset; interface
to hub could be a specific
application or web-based;
TCP/IP; web-based protocols
 HL7 CDA R2; IHE ITI
XCA, XDM, XDE, XDS,
XDS-SD, PDQ, PDQv3,
PIX, PIXv3; IHE PCC
MS, XPHR, CM
Exit from
SmartCare
service
  Care summary   Healthcare Record
system, GP record
system, Social care
record system
  HL7 CDA R2; IHE ITI
XCA, XDM, XDE, XDS,
XDS-SD, PDQ, PDQv3,
PIX, PIXv3; IHE PCC
MS, XPHR, CM